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General NPI Number Information
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NPI Number | 1447611694
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Entity Type | Individual
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Provider Name | ERIC W ALLEN LPC
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Gender | Male
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 232 GOODMAN RD W
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City | SOUTHAVEN
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State | MS
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Zip | 38671-8004
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Country | US
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Telephone | 662-469-3216
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Fax |
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Provider Business Mailing Address
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Address Line | 861 SHADOW VIEW DR
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City | HERNANDO
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State | MS
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Zip | 38632-8086
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Country | US
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Telephone | 731-439-1504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2323
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License Number State | MS
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